GWooREV.txt
Dear Reader,
Subject: Second-opinion ODs who help their own children.
The majority-opinion is that the minus lens is "perfect", and
that anyone who "objects" -- is wrong.
Steve Leung will support you with BOTH METHODS. He is a
professional -- and you should make your choice before you put
your child into a strong minus lens.
I PERSONALLY would have liked to be supported by a
prevention-minded optometrist like Steve -- who helps his own
children with the concept.
There is hostility against the PREVENTIVE plus lens.
George Woo specifies issues "a" through "l".
The response follows his letter to C. Li.
This exchange should explain the nature of the "objection" to
the use of the plus FOR PREVENTION.
Some of the remarks by George are simply false, specifically
about Francis Young "participating" in the Houston study.
In terms of plus-prevention, the Oakley-Young study strongly
supported THAT concept.
Make up your mind up accordingly -- before your child's
Snellen goes below 20/60, or approximately -1.5 diopters.
Sincerely,
Otis
====================================
From: George Woo, (Majority-opinion optometrist)
To:
Mr. Charling Li,
Secretary,
Optometrists Board
2/F Shun Feng International Center,
182 Queen's Road East
Wanchai, Hong Kong
Dated: December 17, 2004
Dear Ms. Le,
Thank you for inviting me to serve as an expert witness for
your Optometrist Board's inquiry. Attached please find a brief
resume of mine for your reference. Should you require a detailed
copy of my curriculum vitae, please let me know.
The questions given to me are as follows:
"Whether the statements made by Leung In-hong in the leaflet
about the treatment and prevention of myopia, namely the
suggestion of using plus lenses to effectively prevent the
worsening of myopia and to assist people with myopia in the very
early state to recoup their normal vision, can or cannot be
substantiated".
Having read several documents pertaining to Mr. Steve Leung
In-hong's views on his methods of prescribing for myopia, I write
to render my opinion.
Section "a"
Chinese Pamphlet on Myopia (Nearsightedness) Prevention
(Appendix 1)
Mr. Leung In-hong's statement and claims are misleading and
incorrect. He claims that by wearing convex or positive or plus
lenses from 1 to 3 years when someone is developing myopia are
not based on evidence. In the pamphlet, he does not provide any
figures for the amounts of myopia when these positive lenses are
prescribed. The message is that concave or negative or minus
lenses are detrimental to myopia and only convex or positive or
plus lenses should be prescribed for myopia. This is contrary to
any conventional treatment for myopia. His statement that 90 % of
myopia patients are receiving the wrong treatment is incorrect and
misleading.
Section "b"
Note edited by Leung In-hong, Optometrist (Appendix 2)
In a separate note, Mr. Leung In-hong states that the plus
lens is a fogging method. According to him, it is the appropriate
method to save one's eyesight. He advocates wearing these convex
or positive or plus lenses for distant and near viewing. Constant
wearing of these lenses is advocated. He also states that for
those who have already developed myopia, use of these lenses will
stabilize the amount of myopia suggesting that there will be no
further increase in myopia. There is no evidence to support his
statements.
Section "c"
Mr. Han Pak-sun's (Alfred's) complimentary statements
(Appendix 3)
In a table listing his family member's refractive errors,
Mr. Han's remarks on them are incomplete and wrong. I assume Mr.
Han is a layman and therefore is incapable to describe myopia
treatment clearly. However, this information is presumably
distributed by Mr. Leung In-hong.
Section "d"
Dr. Stirling Colgate's letter (Appendix 4)
I note that Dr. Stirling Colgate's letter to the National
Institute of Medicine was dated November 9, 1977. Young et. al.
prospective Houston studies were published in 1985 and 1987
(abstracts attached). Results of the final report by the patient
care team are contrary to the beliefs expressed by Colgate.
Section "e"
Dr. Paul E. Romano's letter (Appendix 5)
With the E-address provided by Mr. Leung In-hong, I tried
and filed to access the book prefaced by Dr. Romano.
Section "f"
Dr. David Guyton's letter via e-mail to Miss. Winnie Chong
(Appendix 6)
It is noted that Dr. Guyton categorically states in his
e-mail that, "clearly the plus lenses would not be beneficial for
distant vision if the individual is already myopic: they are used
for near tasks". Mr. Leung In-hong, on the other hand, is
advocating plus lenses for distance and near use. I cannot agree
more with Dr. Guyton's advocacy that Mr. Leung should initiate
and actual randomized controlled study, over 3 to 5 years, to
determine the effectiveness of the method he is using.
Section "g"
For you information, Edwards et. al. (abstract attached) of
Poly U. did conduct a study on the use of progressive lenses
(full correction for distance and addition lenses for near).
Their study was published in Investigative Ophthalmology and Vision
Science (top impact factor journal in Ophthalmology, Optometry and
Vision Science) in 2002. Their conclusion is as follows:
"The research design used resulted in matched treatment can
control groups. There was no evidence that progression of myopia
was retarded by wearing progressive addition lenses, either in
terms of refractive error or axial length".
Section "h"
Mr. Leung In-hong's letter to Miss Winnie Chong (Appendix 7)
Mr. Leung In-hong cited Dr. Francis Young's statement
published in Contacto, a non-citation indexed journal in 1975 to
support his belief. Subsequently, Young participated in a
prospective Houston study.
[Comment by Otis Brown: I must object. Francis Young did NOT
participate at all. Documentation about this issue is
supplied on this site.]
"For the 124 subjects who completed the study, the mean
changes in refraction were found to be -0.34 D per year for
subjects wearing single vision lenses, -0.36 D per year for those
wearing +1.00 D add bifocal, and -0.34 D per year for those
wearing +2.00 add bifocals. These differences were not
statistically significant."
[Comment by Otis Brown: The Oakley-Young study was conducted with
+1.5 diopters "add", with the plus highly placed, so the
kids could NOT avoid looking THROUGH the plus. The result
with 240+ children was that the single-minus group when
down by -2 diopters in four years, and the "plus" group
when down at a rate of zero diopters per year. This
result is HIGHLY SIGNIFICANT. Francis Young did not
participate in the Houston study, and did NOT agree with
the results -- that contradicted HIS STUDY. At the very
minimum, this supports the concept of plus-prevention as
the second-opinion.]
It should be noted that the Houston study compared bifocal
lens wearing children with single-vision leans wearing children
with identical amounts of myopia. These single vision lenses are
concave or negative or minus lenses. They are not convex or
positive or plus lenses advocated for distance and near use by Mr.
Leung In-Hong.
Section "i"
I take exception to Mr. Lung In-hong's statement that USA is
far ahead of us by 25 years in vision protection for young people.
For your information, Poly U's Myopia Research Center was
evaluated by a panel of world renowned experts in myopia research
two years ago. I am pleased to inform you that our center ranked
2nd in the world. In the last two International Myopia meetings
held in Hong Kong and Guangzhou in 2002 and Cambridge earlier this
year, Poly U's presentation on various aspects of myopia has been
significant.
Section "j"
Mr. Leung In-hong cited scientific studies by three Chinese
scholars. No reference, however, was given by him. Indeed, none
of his references cited by him in his letter, is complete.
Section "k"
Mr. Leung in his letter states that "if the focal adaptation
of eye-sight can be caught at the threshold of the situation --
focal state of zero or slightly negative -- (early myopia), then
clear distant vision can be maintained and/or restored by
systematic use of plus lenses." In an article published in
"vision Research" in 2002 (abstract attached), Chung, et. al.
prove under-correction of myopia enhances rather than inhibits
myopia progression thus nullifying Leung IN-hong's unsubstantiated
arguments.
Section "l"
It is my professional opinion that Mr. Leung In-houg's
statement in the leaflet about the treatment of myopia cannot be
substantiated. His method of prescribing treatment for myopia is
incorrect and inappropriate. His arguments in the various
documents are not convincing and they are not evidence based.
Yours sincerely,
George Woo, OD, PhD, FAAO
Chair Professor of Optometry,
Hong Kong Polytechnic University
Hong Kong SAR
======================================================
Response by Otis S. Brown and Alfred
George = Professor George Woo
Otis = Otis S. Brown
HAN = HAN Bossino (Alfred)
ODs = Majority-Opinion and Minority as listed here
Section "a"
George: Having read several documents pertaining to Mr. Leung's
view on his method of prescribing for myopia, I write to
render my opinion.
George: Chinese pamphlet on myopia prevention (Appendix 1)
George: Mr. Leung's statements and claims are misleading and
incorrect. He claims that by wearing convex lenses from
1 to 3 years when someone is developing myopia are not
based on evidence.
Otis: Direct scientific evidence concerning the dynamic behavior
of the fundamental eye? It is obvious that this man
totally ignores such evidence. It is clear that at least
the objective, scientific facts supports the
"second-opinion", even as the "majority opinion" advocates
continued ignorance of these objective, scientific facts.
This man advocates that the "traditional" minus-lens be
continued, and "objection" to its use be completely
surpressed. This board has the power to enforce their
judgment on Steve Leung
George: In the pamphlet, he does not provide any figures for the
amounts of myopia when these convex lenses are
prescribed. The message is that concave are detrimental
to myopia and only convex lenses should be prescribed for
myopia. This is contrary to any conventional treatment
for myopia. His statements that 90% of myopic patients
are receiving the wrong treatment is incorrect and
misleading.
Otis: This depends on who is "misleading" whom. While I do not
expect any OD to put himself at "professional risk" in
order to offer a "second opinion", I would at least expect
ALL ODs to be sufficiently informed to DISCUSS this
alternative with a person -- before that first minus lens
is applied. At least the person would have an option to
explore more completely the concept of prevention -- and
use it effectively if that were his choice. I think all
"professionals" have this obligation to offer that
discussion. This man judges he has no obligation of that
nature. I urge you to continue to offer this choice to a
person on the threshold -- with no obligation to go beyond
that point.
Section "b"
George: Note edited by Mr. Leung (Appendix 2)
George: Mr. Leung states that the plus is a fogging method.
According to him, it is the appropriate method to save
one's eyesight. He advocates wearing these convex lenses
for distance and near viewing. Constant wearing of these
lenses is advocated.
Otis: The decision to use the plus "aggressively" must depend on
the person's "choice" after he has time to review the
issues and the experimental data itself. The actual use of
the plus would follow this type of review. Effective use
of the plus (for prevention) does require a "strong will",
and a certain belief that the method can be successful for
the person who is going "all-out" to use the plus
correctly.
Otis: Again, this depends on the scientific background of the man
making the statement. A man who has been saturated with
the concept that the eye's refractive status is isolated
from its visual environment, is going to make that type of
sweeping, un-proven statement -- while totally ignoring a
massive amount of direct-experimental data to the contrary.
As long as exclusively "ODs" sit on that "board" you (Steve
Leung) have no chance of fighting this issue. If the board
has some true-scientists, and some people of the "second
opinion" concept you (Steve Leung) might stand a better
chance.
George: He (Steve) also states that for those who have already
developed myopia, use of these lenses will stabilize the
amount of myopia suggesting that there will be no further
increase in myopia. There is no evidence to support his
statements.
Otis: I would agree that is it very important to begin the use of
the plus BEFORE the minus. Once you start with the minus,
the natural eye "adapts" to that minus, making recovery
(beyond 20/70) almost, or virtually impossible. To goal it
to prevent entry in the first place, thus the term
"plus-prevention".
Section "c"
George: Mr. Han's complimentary statements.
George: In a table listing his family members' refractive errors.
Mr. Han's remarks on them are incomplete and wrong. I
assume Mr. Han is a layman an therefore is incapable to
describe myopia treatment clearly. However, this
information is presumably distributed by M. Leung.
HAN: Hey. I wrote those statements by myself. How can you said
that my remarks on my family member's are wrong? Do you
know my family?
Section "d"
George: Dr. Stirling Colgate's letter
George: I note that Dr. Colgate's letter to the NIH was dated
November 8 1977. Young et al's prospective Houston
studies were published in 1985 and 1987. Results of the
final report by the patient care team are contrary to the
belief expressed by Dr. Colgate.
Otis: I have every confidence in Stirling's statement of
effective prevention when the plus is forcefully used
BEFORE the minus lens is used. As the very minimum, it
must be recognized that no "perfect proof" can be supplied
for any opinion.
Otis: Francis Young was only "partially" involved in the Houston
study (if at all) and did not agree with the protocol --
nor the results since they contradicted his own results --
which demonstrated that nearsightedness COULD BE PREVENTED
on the threshold. This "George" is very selective in what
he chooses to report. A "second opinion" board member
would be of great value in this review.
Section "e"
George: Dr. Paul E Romano's letter
George: With the E-address provided by Mr. Leung, I tried and
failed to access the book prefaced by Dr. Romano.
Otis: My book and professor Romano's letter is on the internet.
Dr. G. Woo needs to look harder.
Section "f"
George: It is noted that Dr. Guyton categorically states in his
email that "clearly the plus lenses would not be
beneficial for distance vision if the individual is
already myopic; they are used for near tasks. Mr.
Leung, on the other hand, is advocating plus lens for
distance and for near use. I cannot agree more with Dr.
Guyton's advocacy that Mr. Leung should initiate an
actual randomized controlled study, over 3-5 years, to
determine the effectiveness of the method he is using.
Otis: I advocate that the person himself (pilot) be sufficiently
educated so that he be empowered to make both the eye-chart
and refractive measurements himself. (i.e., an engineering
study at a four year college). Given Francis Young's
results, I have no doubt that pilots on the threshold could
clear their distant vision from 20/40 to 20/20, with
intensive effort with the plus. Since other young men have
already done this -- a formalized study -- conducted by
engineer-scientists could certainly reproduce this obvious
success. The issue will be "who is in control"? If
engineers -- I have high confidence in success. If this
"George" is in "control" I am certain the effort will
"fail" -- for obvious reasons of intense majority-opinion
bias.
Section "g"
George: For your information, Edwards et al of Poly U did conduct
a study on the use of progressive lenses (full correction
for distance and addition for near). The conclusion --
"The research design used resulted in matched treatment
and control groups. There was no evidence that
progression of myopia was retarded by wearing progressive
addition lens, either in terms of refractive error or
axial length"
Otis: Even given the fact that the "children" were too young to
"follow instructions", Professor Francis Young's study
demonstrated that the "plus" group showed a "down" rate of
zero diopters (i.e., myopia development effectively stopped
over 4 years). When two studies contradict each other,
neither one can be "right" and you must look at DIRECT
experimental data taken on an "input" versus "output" basis
on adolescent primates. This experiment proved what the
"bifocal studies" could never prove -- that the natural eye
always moves "down" when you place it in a more-confined
visual environment or a -3 diopter lens on it. Obviously
this majority-opinion professor NEVER wants these
scientific facts to see the light of day.
Section "h"
George: Mr. Leung's letter to Miss Chong
George: Mr. Leung cited Dr. Young's statement published in
Contacto, a non-citation indexed journal in 1975 to
support his belief. Subsequently, Young participated in
a prospective Houston study. The final report entitled
Houston myopia control study: a randomized clinical
trial, Part @. Final report by the patient care team,
was published in Am. J of Optometry and Physiological
Optics 1987.
George: "For the 124 subjects who completed the study, the mean
changes in refraction were found to be -0.34 per year for
subjects wearing single vision lenses, - 0.36D per year
for those wearing +1.00 addition, and - 0.34 per year for
wearing +2.00 add bifocal. These differences were not
statistically significant."
Otis: First of all, Francis Young never participated in the
Houston study. I asked him about it, and he did not even
have a COPY of the study -- either the staring or ending
document. He was not aware that his name was listed on the
first document!
Otis: As Francis Young pointed out, they used a "small plus" in
the lower segment. Very often the young child would avoid
looking THROUGH the plus. For this reason the study was
not "controlled" in any meaningful scientific sense.
Otis: Francis Young's Pullman study used a strong, high-placed
plus, where the kid HAD TO LOOK THROUGH THE PLUS. I
remember the numbers to be about 240+, where the half
wearing the plus showed no "down" movement, were the
single-minus when "down" at a steady -1/2 diopter per year.
George: It should be noted that the Houston study compared
bifocal lens wearing children with single vision lens
wearing children with identical amount of myopia. These
single vision lenses are concave. They are not convex
lenses advocated for distance and near use by Mr. Leung.
Otis: At the very minimum, the fact that Dr. Young's study
produced a profoundly different result should ALWAYS be
discussed. Francis Young did not think much of the
"Houston" study for the reasons stated above.
Section "i"
George: I take exception to Mr. Leung's statements that USA is
far ahead of us by 25 years in vision protection for
young people. For your information, Poly U's myopia
research center was evaluated by a panel of world
renowned experts in myopia research two years ago.
Otis: Yes, and 92 percent of the medical doctors on Taiwan are
myopic. Does this sound like effective "preventive" work.
Or blindly following the "traditional" method of the last
400 years -- regardless of consequences, or ignoring the
massive amount of DIRECT, SCIENTIFIC data that suggests
that the traditional minus lens creates very serious
long-term vision problems for all of us.
George: I am pleased to inform you that our center ranked 2 in
the world. IN the last two international myopia meetings
held in HK and Guagzhou in 2002 and Cambridge earlier
this year, Poly U's presentations on various aspects of
myopia has been significant.
Otis: And with all their impressive "expertise" how much myopia
have they "prevented"? In fact, 85 percent of Hong Kong
high school graduates entering college are myopic. Is this
the type of success Dr. Woo is talking about in
"successful prevention"?
HAN: Spending money to carry research, but in no way to suppress
the wide spread of myopia -- Poly U's Center rank 2 in the
world, but Hong Kong is the No.1 dense myopic population in
the World. Do you not feel SHAME?
Section "j"
George: Mr. Leung cited scientific studies by three Chinese
scholars. No reference, however, was given by him.
Indeed, none of his reference cited by him in his letter,
is complete.
HAN: Dr. Xu Guang Dis, Dr. Jung Yun Xin, Dr. Wang Fang Yun,
all of them are most famous eye doctor in China. Maybe
George don't read any Chinese ophthalmic books at all.
Section "k"
George: Mr. Leung in his letter states that "...if the focal
adaptation of eye-sight can be caught at the threshold of
the situation-focal status is zero or slightly negative
(early myopia), then clear distance vision can be
maintained/or restored by systematic use of plus lenses"
In an article published in Vision Research in 2002, Chung
et al proved under-correction of myopia enhances rather
inhibits myopia progression thus nullifying Leung's
unsubstantiated arguments.
Otis: Here again the "George" is selectively reporting what he
wants to believe. A person who is "impartial" would have
no problem discussing Francis Young's Pullman study. This
is a matter of selective bias and preferred ignorance.
Section "l"
George: It is my professional opinion that Mr. Leung's
statements in the leaflet about the treatment of myopia
cannot be substantiated.
Otis: Fine, I accept that George's statement is the "majority
opinion". In no sense should George's statement be allowed
to suppress the concept that the natural eye is "dynamic",
nor does his statement PROVE that actions should be taken
against you to "shut you up -- or shut you down". But we
are talking about naked political power of the Board" --
and not about scientific truth as it concerns the dynamic
behavior of the fundamental eye.
George: His method of prescribing/treatment for myopia is
incorrect and inappropriate. His arguments in the
various documents are not convincing and they are not
evidence based.
Otis: The fact that there is a "majority opinion" and "second
opinion" means that "arguments and documents" are not
"convincing" to EITHER group. That does not mean that
either group is wrong. It is just that two contradictory
methods must exist side-by-side for some time into the
future.
Otis: In the long history of medicine (and science) this is about
the only method that allows for necessary and fundamental
scientific change.
Sincerely,
Otis Brown